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Objective:To evaluate and compare the foveal microvascular morphology and central foveal thickness (CFT) after laser retinal photocoagulation and intravitreal injection of anti-vascular endothelial growth factor (VEGF) in patients with retinopathy of prematurity (ROP), and to explore the factors affecting the prognosis of vision.Methods:A cohort study was conducted.Forty children (40 eyes) aged 4-6 years, who had been treated in Peking University People's Hospital for type 1 ROP from January 2019 to December 2020, were enrolled.Optical coherence tomography angiography (OCTA), best corrected visual acuity (BCVA) and refractive status of the patients were examined.The patients were divided into laser retinal photocoagulation group and anti-VEGF group according to they received a single laser retinal photocoagulation therapy or a single intravitreal injection of anti-VEGF drugs (conbercept or ranibizumab 0.25 mg/0.025 mL) after birth.Twenty age-matched full-term healthy children (20 eyes) were enrolled as the normal control group.The FAZ area, superficial and deep foveal vessel density (VD) and CFT of the affected eyes were measured by OCTA at 4-6 years after treatment to investigate the influence of gestational age, birth weight, morphological characteristics of foveal microvessels and CFT on the prognosis of BCVA.This study protocol adhered to the Declaration of Helsinki and was approved by an Ethics Committee of Peking University People's Hospital (No.2017PHB179-01). Written informed consent was obtained from the guardians prior to any medical examination.Results:There were statistically significant differences in FAZ area, superficial foveal VD and deep foveal VD among the three groups ( F=12.321, 8.436, 5.497; all at P<0.05). The FAZ area was smaller, and the superficial and deep foveal VD of the laser photocoagulation group and the anti-VEGF group were greater than those in the normal control group, and the difference was statistically significant (all at P<0.05). The CFT of the laser photocoagulation group was (267.6±11.8)μm, greater than (259.5±12.9)μm of the anti-VEGF group and (242.4±12.3)μm of normal control group, and the CFT value of the anti-VEGF group was greater than that of the normal control group, and the differences were statistically significant (all at P<0.05). There was a strong negative correlation between the superficial foveal VD and FAZ area ( r=-0.713, P<0.05), a moderate negative correlation between the deep foveal VD and FAZ area ( r=-0.565, P<0.05), and a moderate positive correlation between gestational age and FAZ area ( r=0.485, P<0.05). Pearson correlation analysis results showed that gestational age, FAZ, superficial foveal VD, deep foveal VD, CFT were all correlated with BCVA (all at P<0.05). The effects of gestational age and FAZ on BCVA were both statistically significant ( R2=0.615, both at P<0.05). Conclusions:The morphology of microvessels in macular fovea and the prognosis of BCVA in the affected eye is similar at 4-6 years after laser retinal photocoagulation and intravitreal injection of anti-VEGF drugs for type 1 ROP.The CFT of the affected eye after anti-VEGF drug therapy is better than those after laser retinal photocoagulation.Gestational age and FAZ are the influencing factors of visual acuity after treatment in children with type 1 ROP.
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Objective:To evaluate the pathological features of bilateral retinoblastoma (RB) and the relationship between different treatments and high-risk histopathologic features (HHF).Methods:Retrospective series of case studies. From 1999 to 2018, 73 patients with binocular RB diagnosed by pathological examination in Department of Ophthalmology, Peking University People's Hospital were included in the study. Among them, 50 patients were male (68.5%, 50/73), 23 patients were females (31.5%, 23/73); 11 patitents had a family history of RB. The mean age at the first diagnosis was 14.8±15.6 months. The average time between first diagnosis and first intervention was 3.97±4.74 months. According to the international classification standard of intraocular RB staging, among the 73 eyes, C, D and E stages were 2 (2.7%, 2/73), 15 (20.5%, 15/73), and 56 (76.7%, 56/73) eyes, respectively. Ocular images for each patient were obtained using a wide-angle contact fundus camera during examination under general anaesthesia. The treatment protocol (globe salvaging or enucleation) depended on the result of several clinical features. Globe salvaging treatment included chemotherapy combined with local therapy such as intra-arterial chemotherapy (IAC), intravitreal chemotherapeutics injection, cryotherapy, laser, transpupillary thermotherapy and radiotherapy. If globe salvaging failed, enucleation was offered and histopathologic analysis was conducted of the enucleated eye, the ophthalmic pathologist read and evaluated the presence of HHF. Independent samples t-test was performed to compare the continuous variables. The pathological features and the relationship between different treatments and HHF were analyzed. Group difference was calculated with chi-square. Results:Among the 73 eyes, the first treatment was enucleation in 21 eyes (28.8%, 21/73); 52 eyes (71.2%, 52/73) were treated with eye protection. After enucleation, 9 cases (12.3%, 9/73) had recurrence and metastasis, and 7 cases (9.6%, 7/73) died. The intervention time of patients with recurrence and metastasis and those without recurrence and metastasis were 7.4±7.3 and 3.5±4.1 months respectively; the first intervention time of patients with recurrence and metastasis was significantly later than that of patients without recurrence and metastasis, but the difference was not statistically significant ( t=-1.561, P=0.154). The pathological examination results showed that there were 26 eyes (35.6%, 26/73) with HHF, 4 (26.7%, 15/26) and 22 (39.3%, 22/56) eyes were in stage D and E, respectively. Those who received other treatments before enucleation had lower HHF percentages after enucleation than those who did not receive corresponding treatments, but the difference was not statistically significant ( χ2=1.852, 0.074, 0.000, 1.007, 0.007, 2.729; P>0.05). Among the 26 eyes, 5 (83.3%, 5/6) and 21 (31.3%, 21/67) eyes were treated with systemic chemotherapy combined with and without IAC, respectively, and there was a significant difference in the percentage of HHF ( χ2=4.422, P=0.035). Conclusions:IAC eye-preserving therapy before enucleation has a significant effect on HHF.
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Prevention and treatment of infants and young children can avoid blindness, effectively reduce the incidence of children's blindness and vision loss. Eye diseases causing blindness in infants and young children mainly include retinopathy of prematurity, retinoblastoma, familial exudative retinopathy, persistent embryonic blood vessels, vitreous hemorrhage, congenital cataract, etc. Most of them are preventable and controllable, however, many diseases have strict requirements for the effective treatment time window. The basic form and path to carry out the prevention and control of blinding eye diseases in infants and young children are building a prevention and control system with a combination of multi-party medical forces, referral to pediatric eye disease institutions with relevant technical resources for further diagnosis and treatment, so as to achieve early detection, standardized treatment and visual training.
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Objective:To observe the curative effect, survival rate, enucleation rate and pathological characteristics of retinoblastoma (RB) in children.Methods:Retrospective clinical study. From March 1999 to December 2018, a total of 313 patients (445 eyes) with RB diagnosed in Ophthalmology Department of Peking University People’s Hospital were enrolled in the study. Among them, 175 were male (55.9%), 138 were female (44.1%); 181 were monocular and 132 were binocular. The international standard of intraocular RB staging (IIRC) was 6, 13, 6, 52, 227 and 9 patients of A, B, C, D, E and extraocular stages respectively. Among the 313 patients, 245 patients were confirmed to the survivance, of which 22 cases (9.0%, 22/245) died. Among 445 eyes, 330 eyes definitely whether or not were enucleated; 184 eyes had definite IIRC stage, eye examination results, definite treatment plan and times before enucleation and definite pathological tumor node metastasis stage after operation. The basic information, demographic characteristics, clinical information, enucleation and treatment plan, pathological and immunohistochemical results were recorded. Binary logistic regression was used to analyze the risk factors of high risk pathological features (HRF) and prognosis in patients with RB.Results:From 1999 to 2018, the survival rate of 245 patients was increased from 82.6% to 96.3% year by year; the enucleation rate of 330 eyes with final enucleation was reduced from68.8% to 58.3% year by year. The rate of enucleation in stage D and stage E decreased from 83.3% and 100% before 2005 to 37.5% and 85.4% after 2014, respectively. Monocular disease ( β=-1.551, P=0.005), stage D, stage E and extraocular stage in IIRC stage ( P<0.005) were the independent risk factors of RB enucleation, while the protective factors were Interventional chemotherapy of ophthalmic artery (IAC) ( β=-0.877, P<0.001). HRF was found in 51 eyes (27.7%). Age of onset ( β=0.019, P=0.016) and glaucoma ( β=0.816, P=0.050) were independent risk factors for HRF in RB pathology, while IAC treatment was the protective factor for enucleation ( β=21.432, P<0.001). Conclusions:After comprehensive treatment, the general trend of RB enucleation rate is gradually decreasing. IAC treatment can reduce the enucleation rate of stage D and E. The older age of onset and glaucoma stage are the independent risk factors of HRF, and IAC can reduce the risk factors of HRF.
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Thanks to the treatment of retinoblastoma (RB) having improved significantly in recent years,there is an increasing trend to use conservative treatment modalities that aim to preserve the globe as well as vision with minimum mortality.RB therapy is a long-term systemic treatment in clinical practice.Although there are many treatment options for RB therapy,such as cryotherapy,photocoagulation,systemic chemotherapy,enucleation and ophthalmic chemotherapy,it is recommended to consider in accordance with the following key points in gaining a reasonable treatment strategies:to make sure that RB is an intraocular period;to determine whether the intraocular RB to be treated with eye preservation or enucleation;what is the case of eye preservation therapy combined with chemotherapy and how to arrange the follow-up of RB patients.It's more complicated to choice the therapeutic measures for RB in clinical practice.So,the patient's condition,economic capability and medical condition should be evaluated comprehensively.The principle of RB treatment should be followed,which is protecting eyeball and visual function without life damage.
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Objective To compare the predicted efficiency ofmacular hole closure index (MHCI) calculated by 2 different methods for postoperative anatomical outcomes after idiopathic macular hole (MH) surgery.Methods This is a prospective exploratory clinical study.A total of 63 patients (63 eyes) with idiopathic MH,who received vitrectomy,inner limiting membrane peeling and gas tamponade,were enrolled in this study.All the patients received optical coherence tomography (OCT) examination at each visit to measure the MHCI using the formula MHCI=(M+N) /BASE,M and N is the distance from outer limiting membrane break points to the beginning points of detached photoreceptor from retinal pigment epithelium of both side of the hole,respectively.BASE is the length of MH base.MHCI1 was measured by built-in caliper of OCT software,MHCI2 was measured by ImageJ software.The minimum macular diameter (MHD) was measured by built-in caliper of OCT software.Based on the OCT images,the anatomical outcomes were classified grade A (bridge-like shape closure),grade B (complete closure) and grade C (poor closure).Grade A and B are considered as good closure,grade C as poor closure.Patients were followed up at 3,6 and 12 months after surgery.The closure grades at last visit were the final outcome.The relationship between MHCI 1,MHCI2 and closure grades was analyzed.And the predicted efficiency of MHD,MHCI1 and MHCI2 for anatomical outcomes after the surgery was studied.Results The mean MHCI1 was 0.68±0.21 (0.30-1.35),MHCI2 was 0.95±0.26 (0.41-1.55),and MHD was (476.24±210.18) μm (127-956 μm).MHCI1 and MHCI2 were both negative correlated with the closure grades (r=-0.665,-0.691;P＜0.001).The receiver operating characteristic (ROC) curve analysis ofMHCI1,MHCI2 and MHD for the prediction of good or poor closure showed that area under the curve (AUC) was 0.928,0.957 and 0.916 respectively,and 0.505,0.67 and 559 μm were set as the lower cut-offvalue.The sensitivity was 96.2％,92.3％ and 90.9％ respectively,and specificity was 81.8％,72.7％ and 76.9％ respectively.Accordingly,the ROC curve analysis for the prediction of grade A or B closure showed that AUC was 0.840,0.847 and 0.653 respectively,and 0.705,0.965 and 364 μm were set as the upper cut-off value.The sensitivity was 80.0％,82.9％,63.4％ respectively and specificity was 75.0％,85.7％,65.9％.Conclusion MHCI1 and MHCI2,measured by built-in caliper of OCT software or ImageJ software,both have good predictive efficiency for the anatomical outcomes of MH surgery.
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Objective To observe the effects of intravitreal injection of conbercept for aggressive posterior retinopathy of prematurity (AP-ROP).Methods It is a retrospective case study.Twenty-one patients (40 eyes) with AP-ROP were enrolled in this study.There were 9 males (18 eyes) and 12 females (22 eyes),with the mean gestational age of (28.30±1.79) weeks and the mean birth weight of (1 021.40±316.70) g.All the lesions of 40 eyes were located in posterior zone,with 24 eyes in zone Ⅰ and 16 eyes in zone Ⅱ.All the eyes were treated with intravitreal injection of conbercept 0.025 ml (0.25 mg).During follow-up,nonresponders or patients with deterioration were retreated with intravitreal injection of conbercept or photocoagulation;patients with progressive deterioration to stage 4 had received vitrectomy.At the 1,2,4,8,12,16,20,24 weeks after treatments,the disappearance or decrease of retinal vessel tortuosity and neovascularization,and the growth of the normal retinal vessels toward the peripheral retina were evaluated.Results Thirty-six eyes were cured for only one injection,the cured rate was 90.00％.However,2 eyes (5.00％) had progressed to stage 4 with contractive retinal detachment,which underwent vitrectomy.Two eyes (5.00％) had received twice injections,whose remaining avascular zone area treated by photocoagulation.No major systemic or ocular complications after injection appeared.All lens remained transparent and no iatrogenic retinal hole was occurred during the follow-up.Conclusion Intravitreal injection ofconbercept is effective in the treatment of AP-ROP.
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Objective To observe visual field outcome and refractive status of patients with retinopathy of prematurity (ROP) treated by laser photocoagulation.Method The data of 39 ROP patients (73 eyes) who received laser photocoagulation were retrospectively analyzed and compared with 13 normal control subjects (25 eyes) whose age and sex were matched with ROP group.There were 24 males (45 eyes) and 15 females (28 eyes) in ROP group,with an average age of (7.0± 1.28) years.The first laser treatment was carried out at postnatal age (PA) of (38.74±3.82) weeks,the birth weight (BW) of (1402.33 ±369.61) g and the number of laser burns was (517.86 ± 277.40).The control group included 7 females (13 eyes) and 6 males (12 eyes),with an average age of (7.17 ± 0.96) years.The age (t=0.691) and gender (x2=1.425) were comparable between the two groups (P=0.491,0.233).The data of patients and controls were retrospectively analyzed including best corrected visual acuity,refractive examination,automated perimetry test.The differences of the mean deviation (MD) of visual field and the spherical equivalent (SE) between these two groups were comparatively observed.ROP patients were divided into no VF loss group (MD≤2 dB) and VF loss group (MD＞2 dB),mild VF loss group (MD ≤ 6 dB) and moderate VF loss group (MD ＞6 dB) according to the results of automated perimetry test,the differences of gestational age (GA),PA,BW,number of laser burns and SE between these groups were comparatively observed.Results The MD in ROP group and control group were 4.87±5.12 dB and 1.27 ± 3.34 dB,respectively;the difference between the two groups was statistically significant (t=-4.01,P＜ 0.001).The subgroup analysis showed that BW,number of laser burns,and SE were significantly different between no VF loss group and VF loss group (t=2.074,-1.996,-2.162;P=0.042,0.026,0.034);while the GA was not significantly different between these two groups (t=1.973,P=0.052).The difference of PA was not statistical significant different between mild VF loss group and moderate VF loss group (t=2.03,P=0.051) and SE was significantly different between the above two groups (t=3.283,P=0.002).For refractive outcomes,the BW and ROP stage correlated with SE significantly (r=-0.304,-0.387;P=0.015,0.002).The mean BCVA in ROP group was 0.84±0.23,and 59 eyes (91.2％) with BCVA better than 0.5.Conclusion Laser treatment for ROP tends to have less effect on long term refractive status and VF loss,with good visual outcome.
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Objective To observe the therapeutic effect of segmental scleral buckling and vitrectomy with/without lensectomy on the retinopathy of prematurity (ROP) stage 4a,4b and 5.Methods One hundred and thirty-four ROP infants (181 eyes) diagnosed as stage 4a,4b and 5,and performed with segmental scleral buckling or vitreous with/without lensectomy were retrospectively analyzed.The operated 4a-,4b-and 5-stage eyes were 40,51 and 90 eyes.The operational method depended on the location and severity of fibrovascular membrane.Of 181 eyes,segmental scleral buckling was referred for 37 eyes which include 23 eyes with 4a stage and 14 eyes with 4b stage;vitrectomy was referred for 50 eyes which include 14 eyes with 4a stage,29 eyes with 4b stage and 7 eyes with 5 stage;vitrectomy with lensectomy was referred for 94 eyes which include 3 eyes with 4a stage,8 eyes with 4b stage and 83 eyes with 5 stage.The effect was classified as success,improved and failure.Failure includes lost eye.Follow-up for 4a,4b and 5 stage patients are 34,31 and 29 months respectively.Results Segmental scleral buckling was referred for 37 eyes,success in 23 eyes (62.16％),improved in 11 eyes (29.73 ％),failure in 3 eyes (8.11 ％).Vitrectomy was referred for 50 eyes,and success in 20 eyes (40.00％),improved in 22 eyes (44.00％),and failure in 8 eyes (16.00％).In the total of 94 eyes underwent vitrectomy with lensectomy,20 eyes was success (21.28％),improved in 17 eyes (18.08％),failure in 57 eyes (60.64％).In 40 stage 4a eyes,33 successes (82.50％),6 improved (15.00％) and 1 failure (2.50％).In 51 stage4b eyes,11 successes (21.57％),30 improved (58.82％) and 10 failures (19.61％).For 90 stage 5 eyes,14 successes (17.50％),19 improved (23.75％) and 57 failures (71.25％).The therapeutic effect of segmental scleral buckling for stage 4a was better than that for stage 5 (x2 =6.707,P=0.035).The difference of therapeutic effect of vitrectomy for different stage was significant (x2=21.010,P =0.000);stage 4a was the best;stage 4b was the second,stage 5 was the worst.The therapeutic effect of vitrectomy with lensectomy for stage 5 was worse than that for stage 4a and 4b (x2=16.066,P=0.003).Conclusion The surgery patterns of ROP was determined based on the disease severity,the surgery effects of stage 4a and 4b were better than stage 5,which had nothing to do with the surgical procedures.
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Objective To observe the clinical effect of small gauge vitrectomy (SGV) treatment for proliferative diabetic tractional (PDR) with retinal detachment (TRD).Methods The data of 42 patients (50 eyes) with PDR combined with TRD who had received SGV treatment were retrospectively analyzed.There were 22 males and 20 females,with an average age of (44.5±11.2) years.There were 16 eyes with TRD involving the macular area,34 eyes without TRD involving the macular area.The eyes with rhegmatogenous retinal detachment or retinal hole were excluded.The best corrected visual acuity (BCVA) was worse than finger counting in 18 eyes,worse than 0.1 in 15 eyes,0.1-0.3 in 16 eyes and better than or equal to 0.3 in 1 eye.Post operative tamponade was delivered for patients with iatrogenic retinal breaks,including 5 eyes with long acting gas and 7 eyes with silicone oil.The mean follow-up time was 9.7 months.The visual outcome,rate of retinal reattachment and complications were analyzed.Results The visual acuity improved in 34 eyes (68.0％),unchanged in 12 eyes (24.0％) and decreased in 4 eyes (8.0％).The difference of visual acuity before and after surgery was statistically significant (t=7.087,P＜0.01).The total rate of retinal reattachment was 96％,and 84％ of eyes achieved anatomic reattachment after single surgery.The rate of retinal reattachment was 89.5％ (34/38) for these eyes without iatrogenic retinal breaks,4/38 eyes without iatrogenic retinal breaks still had retinal detachment in 3 months after surgery and received tamponade of long-acting gas or silicone oil.The rate of retinal reattachment was 66.7 ％ (8/12) for these eyes with iatrogenic retinal breaks and received post-operative tamponade.There were 17 eyes experienced postoperative vitreous hemorrhage,which were treated with anti-vascular endothelial growth factor (VEGF) antibodies or vitreous cavity lavage.There were 9 eyes with transient ocular hypertension,and 4 eyes with neovascular glaucoma (NVG).Among 4 eyes with NVG,2 of which were controlled through anti VEGF treatment or laser treatment,and 2 eyes of 2 patients refused to have further treatment.Conclusion SGV is safe and effective treatment for PDR combined with TRD,and intraocular tamponade is not necessary in the absence of iatrogenic retinal break.
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Objective To observe the surgical effects of scleral buckling and vitrectomy for familial exudative vitreoretinopathy (FEVR).Methods 34 eyes of 27 patients with FEVR who underwent either scleral buckling or vitrectomy were enrolled in this study.There are stage 2B in 2 eyes (5.88％),stage 3B in 7 eyes (20.59％),stage4Ain 1 eye (2.94％),stage4Bin 16 eyes (47.06％),stage 5 in8 eyes (23.53％).5 eyes associated with rhegmatogenous retinal detachment.The surgical approaches had been chosen according to the disease stage,severity,extent and morphology of the proliferative membrane.13 eyes (stage 2B in 2 eyes,3B in 4 eyes,and 4 in 7 eyes) underwent scleral buckling and 21 eyes (stage 3B in 3 eyes,4 in 10eyes,and 5 in 8 eyes) underwent vitreoretinal surgery.The main outcome measurement was the anatomic status of the macula,which was recorded as attached,partially attached or remain detached.The mean follow up was (18.00 ± 14.61) months (range 4 to 60 months).Results Among 13 eyes received scleral buckling,the macula was attached in 2 eyes with stage 2B (15.38％),partially attached in 11 eyes (84.62％) including 4 eyes with stage 3B,1 eye with stage 4A and 6 eyes with stage 4B.Among 21 eyes received vitrectomy,the macula was attached in 8 eyes (38.10％) including 2 eyes with stage 3B,4 eyes with stage 4 and 2 eyes with stage 5;the macula was partially attached in 9 eyes (42.86 ％) inducing 4 eyes with stage 4 and 5 eyes with stage 5;the macula remained detached in 4 eyes (19.05％) including 1 eye with stage 3B,2 eyes with stage 4 and 1 eye with stage 5.Conclusion If the surgical approaches were chosen based on the stage of FEVR and the severity,extent and morphology of the proliferative membrane,the surgery is effective and beneficial to FEVR patients.
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Objective To explore the clinical significance of changes of serum IL-1,IL-6 and TGF-β1 in pa-tients with Knee osteoarthritis(KOA).Methods Serum IL-1,IL-6 and TGF-β1 levels were measured by ELISA in 100 patients with KOA and 100 health control .Results The KOA group serum IL-1 and IL-6 levels were higher than those of the healthy control group (t=71.132,t=78.503,all P<0.01),while the level of TGF-β1 was converse(t=36.165,P<0.01);The levels of serum IL-1 and IL-6 increased gradually with the increase of the severity ,while.the level of TGF-β1 was decreased;the serum level of TGF-β1 was negative correlation with the level of IL-6,IL-8 in patients with KOA(r=-0.633,r=-0.615,all P<0.05),the serum level of IL-1 was positive correlation with the level of IL-6(r=0.730,P<0.01).Conclusion The serum IL-6,IL-8 and TGF-β1 reflect situation of patients and extent of Joint injury ,which is close relationship between the clinical process of KOA and has significance value to evaluate the pathogenetic condition and prognosis .
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Background There remains some controversy over whether polypoidal choroidal vasculopathy (PCV) represents a subtype of neovascular age-related macular degeneration (nAMD).Anti-vascular endothelial growth factor (VEGF) therapies are important in the treatment of PCV and nAMD.It has been identified that VEGF-A was differentially spliced from exons 8 and formed two isoforms families:the pro-angiogenic VEGFxxx family and the anti-angiogenic VEGFxxxb family.However,the role of the two VEGF families in PCV and nAMD was still unclear.Objective This study was to measure the contents of pro-angiogenic VEGFxxx family and the anti-angiogenic VEGFxxxb family in aqueous humor of nAMD and PCV patients and explore their effect on nAMD and PCV.Methods Thirty-four nAMD patients and 26 PCV patients were enrolled in Peking University People's Hospital during March to December,2013,and 16 age-related cataract patients served as controls.The aqueous humor samples 0.1 ml was collected before the introvitreous injection of anti-VEGF drug.The contents of pro-angiogenic VEGFxxx family and the anti-angiogenic VEGFxxx b family in the aqueous humor were measured by enzyme-linked immunosorbent assay(ELISA).Results The concentrations of VEGF in the aqueous humor in the nAMD group,PCV group and control group were (4 210.00±998.40),(387.00±51.31) and (377.40 ±69.97)pg/ml,respectively,showing a significant difference among the three groups (F =12.851,P =0.000).The concentrations of VEGF165 b in the aqueous humor in the nAMD group,PCV group and control group were (205.50±12.59),(159.40±16.25) and (347.90±29.18) pg/ml,with a significant difference among them (F=23.752,P=0.000).Compared with the control group,VEGF content in the aqueous humor was elevated and the VEGF165b content was declined in the nAMD group,and VEGF165b was lowed in the PCV group,with significant differences between them(all at P=0.000).However,no significant difference was seen in the change of VEGF between the PCV group and the control group (P=0.992).The VEGF content in the aqueous humor was higher in the nAMD group than that in the PCV group (P =0.001),but VEGF165b content was insignificantly different (P =0.097).Conclusions The downregulation of VEGFxxx b may be associated with nAMD and PCV.The different role of VEGFxxx b in the development of PCV and nAMD needs to be verified in further studies.
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Objective To compare the efficacy and safety of laser photocoagulation and intravitreal injection of bevacizumab for stage 3 retinopathy of prematurity (ROP).Methods The study included 38eyes of 19 infants with stage 3 ROP (18 eyes of 9 infants in zone Ⅰ,20 eyes of 10 infants in zone Ⅱ ).All the patients were examined by indirect ophthalmoscope and photographed by wide-angle digital retinal imaging system (RetCam Ⅱ ). The fundus lesions in both eyes were the same. Patients received laser photocoagulation in one eye (laser group) and intravitreal injection of 0.03 ml bevacizumab (25 mg/ml) in the fellow eyes (bevacizumab group) during treatment.Follow-up ranged from 12 to 66 weeks,with an average of 33 weeks. The regression time of neovascular ridges and plus-diseases in two groups were compared.Results For 18 eyes with stage 3 ROP in zone Ⅰ,the regression time of neovascular ridges and plus-diseases were (2.25 ±0.46) and (2.11 ±0.60) weeks respectively in bevacizumab group,and both were (3.75 ± 1.75) weeks in laser group.The differences between those two groups were statistically significant (F=18.29,15.56；P＜0.05).For 20 eyes with stage 3 ROP in zone Ⅱ,the regression time of neovascular ridges and plus-diseases were (3.1 ±1.72) and (2.1 ± 0.56) weeks respectively in bevacizumab group,and were (3.50± 1.90) and (2.50± 1.35) weeks respectively in laser group.The differences between those two groups were not statistically significant (F =0.38,2.62 ; P＞ 0.05).There were more fibrous membrane proliferations on the retinal surface in 8 eyes,including 6 eyes in laser group and 2 eyes in bevacizumab group. There was no treatment-related endophthalmitis,cataract,retinal tears and other complications during the follow-up.Conclusion The laser photocoagulation and intravitreal injection of bevacizumab were both safe and effective in treating stage 3 ROP.
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Objective To evaluate the anatomic outcome after lens-sparing vitrectomy (LSV) or scleral buckle (SB) for stage 4 retinopathy of prematurity (ROP).Methods The clinical data of 39 infants (50 eyes) with 4a (20 eyes) or 4b (30 eyes) were retrospectively analyzed.The age ranged from two to 18 months,with a mean of (6.0±3.4) months.The gestational age ranged from 26 to 33 weeks,with a mean of (30.0±1.6) weeks.The birth weight ranged from 800 to 1900 g,with a mean of (1404.5±237.6) g.Nineteen eyes underwent SB and 31 eyes underwent LSV.Follow-up ranged from 6 to 84 months,with a mean of (26.0±21.7) months.The anatomical and refractive results were reviewed at the final follow-up.Results The anatomic success of SB was 100.0％ (19 of 19 eyes) and that of LSV was 87.1％ (27 of 31eyes).Among the patients in whom treatment failed,4 were in the LSV group (4/31,12.9％).The buckles of 5 eyes (5/19,26.3％) were removed.At the end of the follow-up,the mean myopic refraction was (-4.46±2.49) diopters (ranging from -1.25 to 11.00 diopters) in the LSV group,and ( -3.21±1.96) diopters (ranging from -1.25 to 9.25 diopters) in the SB group.There was no significant difference between two groups (F=2.76,P=0.103).Conclusion The anatomic outcome after LSV or SB for stage 4 ROP was excellent.
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Objective To observe the value of the high frequency color Doppler uItrasonography in emergency operation of flexor tendon injuries in the hand.Methods Totally 21 patients of flexor tendon injuries in the hand underwent surgical exploration with high frequency probe.The extent of the tendon injuries,the retracted parts of the ruptured tendon and the blood supply were observed.Results The extent of the tendon injuries,the poison of broken ends were clearly distinguished with high frequency probe.The continuous tendon fibrous of layered high echo and sheath thin layer low echo complete broke and replaced with low or no echo.Conclusion Intraoperative uhrasonography of flexor tendon iniuries is important tO shorten operation time,reduce the injury of surrounding tissues,relieve local adhesion and ensure vascular recanalization after operation.
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Background Branch retinal vein occlusion (BRVO)often leads to macular edema as the result of elevating intravitreal VEGF level,and avastin,a anti-VEGF drug,show a good effectiveness on macular edema secondary to BRVO.ObjectiveThis study attempts to evaluate the clinical efficacy of avastin on macular edema induced by BRVO.MethodsThis is a retrospective case-observation study.The clinical data of 39 eyes from 39 patients with macular edema induced by BRVO were included in this analysis.All of the patients received intravitreal injection of 1.25mg (0.05mL)avastin without other any therapy prior to the injection of avastin.This procedure followed the Declaration of Helsinki,and written informed consent was obtained from all the patients before and initial of any management.Clinical indexes included best-corrected visual acuity(BCVA),slit-lamp examination,intraocular pressure and stereoscopic biomicroscopy examination before injection and 3,6 and 12 weeks after initial injection.Optical coherence tomography (OCT),fundus photography,fluorescein fundus angiography(FFA)were performed prior to injection and 6,12 weeks after initial injection.The follow-up period was 3-20 months.ResultsThe mean BCVA was significantly improved at 3,6,12 weeks after injection in comparison with before injection (t=-6.039,-6.182,-4.189,all P=0.000).The mean CMT showed a statistically significantly decline at 6,12 weeks after injection in comparison with before injection(t=8.684,5.019,all P=0.000).No ocular or systemic adverse events were found after intravitreal injection of avastin during the follow-up duration.The numbers of visual acuity-improved eyes were significantly increased in the patients with disease course ≤1 month duration in comparison to ones with the course ≥1 month (P<0.05)in 3 weeks after injection.CMT was obviously decreased in 12 weeks after injection in comparison to before injection between with and without macular perfusion eyes (P<0.05).ConclusionIntravitreal injection of avastin is safe and effective for macular edema induced by BRVO,especially the patients with shorter course of disease.
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Objective To study the inhibitory effect of verapamil and nicardipine on human scar fibroblast in serum-free culture and to compare the effectness of the two drugs.Methods We used MTT method to detect the effect of two drugs on human scar fibroblast proliferation:adding verapamil and nicardipine with different concentrations in the culture of fibroblasts which were in logarithmic growth phase (150,100,50,10,0μmol/L).After 24,72,and 120 h,we used MTT method to detect the cell proliferation,and converted the absorbance into growth inhibitory ratio.Results Verapamil and nicardipine showed the definite inhibition on the hypertrophic scar fibroblast (HSFB) and keloid fibroblast (KDFB) which were cultured in vitro.There was some difference in the action feature.In the earlier period,the effect of verapamil was powerful than that of nicardipine.With time,the effect did not reinforce.When fibroblast had been cultured for three to five days,the inhibition became weak.But nicardipine showed lasting inhibition on fibroblast proliferation.Conclusion Combination of verapamil with nicardipine may be a valuable method in the treatment of scar.
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Objective To evaluate the therapeutic effects of treatments of eye-retaining and enucleation for choroidal melanomas. Methods The clinical data of 44 patients (44 eyes) with choroidal melanomas after eye-retaining treatments and enucleation surgery were retrospectively analyzed. The metastasis, retention rate of eyeball after eye-retaining treatment, and visual acuity prognosis were observed and analyzed. In 44 eyes treated by eye-retaining therapy, transpupillary thermotherapy (TTT) was performed primaryly on 7 (15.9%),~ 106 Ru brachytherapy on 25 (56.8%), and local resection of tumor combined with ~ 106 Ru brachytherapy on 12 (27.3%).The average follow-up period was 13.3 months. Results Forty-four patients had no melanoma metastasis during the follow-up period. In 39 patients (88.6%) who had their eyes retained successfully, the retention rate of eyeball was 100%, 92.9%, and 83.3% in 6, 14, and 24 eyes with small, middle, and large tumor, respectively. In the patients treated by eye-retaining therapy, the visual acuity was ≥0.3 in 11 (28.2%), ≥0.05-